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  • The Thin-Fat Phenotype: Exploring the Paradox of Obesity and Metabolic Health in Asian Indians

    The Thin-Fat Phenotype: Exploring the Paradox of Obesity and Metabolic Health in Asian Indians

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    Summary

    1. South Asians, including Asian Indians, have a distinct body composition known as the “Asian Indian Phenotype” or “thin-fat phenotype,” characterized by higher body fat, visceral fat, and lower skeletal muscle mass compared to other populations.
    2. The Asian Indian Phenotype contributes to an increased risk of insulin resistance, metabolic syndrome, diabetes, dyslipidemia, and cardiovascular diseases among South Asians, even at lower body mass index (BMI) levels.
    3. Physical characteristics like excess dorsocervical fat (buffalo hump) and fat deposits under the chin (double chin) can serve as markers for insulin resistance and metabolic syndrome in South Asians.
    4. Truncal subcutaneous adiposity, measured by skinfold thickness, is more pronounced in South Asians and is associated with insulin resistance and metabolic syndrome.
    5. Measures like waist circumference or waist-hip ratio provide a more accurate assessment of cardiometabolic health in South Asians, as BMI alone may underestimate the metabolic risks they face.

    At any body mass index (BMI) and age, Asian Indians have unique body composition characteristics that set them apart from other populations. They tend to have higher body fat, particularly visceral fat, and larger waist circumference compared to Europids. On the other hand, they often have lower skeletal muscle mass, thinner hips, and shorter legs. These physical attributes, along with specific clinical and biochemical markers, collectively make up what is known as the “Asian Indian Phenotype” or the “thin-fat phenotype.”

    Studies have shown that even at similar levels of total body fat, Asian Indians have larger adipocytes (fat cells) compared to Europids. This is associated with insulin resistance and lower levels of adiponectin, a hormone involved in regulating glucose and lipid metabolism. These factors contribute to the increased risk of metabolic syndrome, diabetes, and cardiovascular diseases among Asian Indians.

    South Asians have unique fat distribution patterns that contribute to a higher risk of cardiometabolic disorders, including abdominal obesity and diabetes.

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    Interestingly, these metabolic abnormalities can be observed in children as young as 8 to 11 years old. South Asian children with a smaller waist circumference may have higher insulin levels compared to their white counterparts with a larger waist circumference. This suggests that the predisposition to visceral fat accumulation and insulin resistance begins early in life.

    In addition to the metabolic differences, South Asians also exhibit higher levels of certain procoagulant factors, such as plasminogen activator inhibitor-1 and fibrinogen. These factors contribute to an increased risk of blood clotting and further enhance the likelihood of developing diabetes and coronary artery disease.

    Specific physical characteristics, such as excess fat in the dorsocervical area (buffalo hump) and under the chin (double chin), have also been identified as potential markers of insulin resistance and metabolic syndrome in Asian Indians. Furthermore, measurements of subscapular and suprailiac skin fold thickness, which reflect truncal subcutaneous adiposity, have shown higher values in Asian Indians and are correlated with insulin resistance and metabolic syndrome.

    The differences in obesity and body composition between South Asians and other populations play a significant role in the increased metabolic disturbances observed in the former. These variations have important implications for understanding the underlying mechanisms, managing, and preventing obesity-related diseases in this population.

    The adipose tissue overflow hypothesis proposed by Sniderman et al. offers an explanation for the unique pattern of fat accumulation and metabolic abnormalities observed in South Asians. According to this hypothesis, Asian Indians have a smaller primary fat depot in the lower extremities, leading to a rapid accumulation of fat in deep subcutaneous tissue and visceral fat depots when they are exposed to excess energy intake. This secondary fat accumulation is associated with higher transmembrane fatty acid fluxes, which contribute to dysglycemia, atherogenic dyslipidemia, and increased vascular disease risk.

    One important observation is that many Asian Indians develop metabolic syndrome and diabetes at a BMI below 25 kg/m², which is typically considered normal in other populations. This highlights the limitations of using BMI alone to assess cardiometabolic risk in this group. Waist circumference and waist-hip ratio are often better indicators of the risk for metabolic disorders among Asian Indians.

    In conclusion, the unique body composition and metabolic characteristics of Asian Indians contribute to their increased susceptibility to metabolic syndrome, diabetes, and cardiovascular diseases. Understanding these factors can help in tailoring prevention and management strategies to address the specific needs of this population.

     

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  • How sweet is too sweet? The truth about jaggery and diabetes!

    How sweet is too sweet? The truth about jaggery and diabetes!

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    Summary:

    1. Jaggery, a traditional sweetener, is often considered a healthier alternative to sugar due to its micronutrient content. However, for people with diabetes, jaggery can be just as harmful as sugar because it contains sucrose, a simple carbohydrate that gets rapidly absorbed into the bloodstream and can cause a rapid rise in blood sugar levels.

    2. Jaggery and sugar have almost the same calorie density and a high glycemic index, meaning they can cause a rapid and higher blood glucose excursion after consumption. This can be problematic for people with diabetes, who need to carefully manage their blood sugar levels to avoid complications such as nerve damage, heart disease, and kidney damage.

    Jaggery and Diabetes: Myths and Facts

    Diabetes is a condition that affects millions of people worldwide, and it requires careful management of diet and lifestyle factors to ensure optimal health outcomes. One common myth surrounding diabetes is that jaggery, a traditional sweetener used in many cultures, is a safe replacement for sugar in people with diabetes. In this article, we will examine the facts and myths surrounding jaggery and diabetes, and explore the reasons why jaggery may not be a suitable alternative for people with this condition.

    Jaggery and Sugar: What’s the Difference?

    Both jaggery and sugar are derived from sugarcane, although the processing methods are different. Jaggery is less refined than sugar, and it retains small amounts of micronutrients such as iron, calcium, and magnesium, whereas refined sugar loses all its nutrients during crystallization. For this reason, jaggery can be a better alternative to refined sugar for those without diabetes, as it contains small amounts of micronutrients that are beneficial for overall health.

    Jaggery and Diabetes: The Truth

    However, when it comes to the use of jaggery in those with diabetes, it is as bad as sugar because the bulk of it is sucrose. Sucrose is a simple carbohydrate that gets digested and absorbed rapidly, resulting in elevated blood glucose levels. Jaggery and sugar both have almost the same calorie density (380 kcal vs. 390 kcal per 100g) and a high glycemic index, which means they cause a rapid and higher blood glucose excursion after consumption. Thus, jaggery consumption is not advised for individuals with diabetes.

    Jaggery and Blood Sugar Levels

    Jaggery is often touted as a healthier alternative to sugar because of its micronutrient content. However, for people with diabetes, the impact on blood sugar levels is the most important consideration. As jaggery is made from sugarcane, it contains sucrose, which is rapidly absorbed into the bloodstream and can cause a rapid rise in blood sugar levels. This can be problematic for people with diabetes, as they need to carefully manage their blood sugar levels to avoid complications such as nerve damage, heart disease, and kidney damage.

    Jaggery and Glycemic Index

    The glycemic index (GI) is a measure of how quickly a carbohydrate-containing food raises blood sugar levels. Foods with a high GI value are rapidly digested and absorbed, causing a rapid rise in blood sugar levels, while foods with a low GI value are digested and absorbed more slowly, resulting in a slower rise in blood sugar levels. Jaggery has a high GI value of around 85, which is comparable to sugar. This means that consuming jaggery can cause a rapid rise in blood sugar levels, which can be problematic for people with diabetes.

    Jaggery and Nutritional Content

    While jaggery does contain small amounts of micronutrients, the overall nutritional content is not sufficient to justify its use as a replacement for sugar in people with diabetes. In fact, jaggery is a concentrated source of calories and carbohydrates, which can contribute to weight gain and elevated blood sugar levels. For people with diabetes, it is essential to choose foods that are low in calories and carbohydrates and high in fiber and nutrients.

    Jaggery consumption is not advised for individuals with diabetes. Although jaggery may retain some micronutrients that refined sugar lacks, it is still a simple carbohydrate that can cause a rapid rise in blood glucose levels.

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    Jaggery and Glycaemic Excursion

    In a typical glycemic excursion graph for sugar and jaggery, we would see a rapid rise in blood sugar levels shortly after consuming either of these sweeteners. This is because both sugar and jaggery are high in carbohydrates and are quickly absorbed into the bloodstream.

    After the initial rise in blood sugar levels, there may be a slight dip as the body releases insulin to help regulate blood glucose levels. However, if too much sugar or jaggery is consumed, blood glucose levels can remain high for an extended period of time, which can increase the risk of complications for people with diabetes.

    It’s important to note that individual responses to sugar and jaggery may vary depending on factors such as insulin sensitivity, physical activity level, and overall diet. Therefore, it’s always a good idea to consult with a healthcare provider or registered dietitian before making any significant changes to your diet.

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  • What is Diabetes Foot and how can you manage it?

    What is Diabetes Foot and how can you manage it?


    According to a WHO (world health organization) report, India has nearly 73 million people living with diabetes in 2017 and this number is estimated to go up to 100 million by 2030.

    The life time risk of a diabetic to develop a diabetic foot ulcer (DFU) is 15%, which means 15 out of every 100 people with diabetes will develop diabetes foot in their life time.

    50% of people with diabetes foot require hospitalization and 20% will require amputation.

    In India, 80% of non-traumatic amputations (amputations that are not due to injuries, accidents) are due to diabetes foot.

    What causes diabetic foot?

    The answer is simple. Uncontrolled diabetes.

    Consistently high levels of blood sugar will damage the linings of the blood vessels (leading to high blood pressure and heart disease) and the nerves (peripheral or diabetic neuropathy).

    The layer covering the nerves is affected by persistent high levels of sugar which leads to loss of sensation especially the legs and the feet. The symptoms are numbness, tingling sensation, muscle pains, weakness and loss of sensation.

    The loss of sensation will cause people with diabetes to ignore their feet completely because they do not know if there is any injury or any pain if it is stuck by something. They may not wash or clean properly also because they don’t feel anything. A combination of nerve damage, blood vessel damage, weakened immune system, improper care and hygiene will lead to ulcers on the feet and lower legs, what we call as diabetes foot (or diabetic foot ulcer).

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    Common Pathway of Diabetic Foot Ulcer Occurrence and Recurrence

    Identifying the symptoms of Diabetes Foot

    Pain and numbness are usually reliable indicators of DFU, however, as people with diabetes are likely to have decreased sensation in their feet, ulcers can be difficult to identify. Patients will have to rely on other cues to identify symptoms, such as:

    • Leakage from the foot that causes stains in socks and shoes.
    • Inflammation, redness and odour, from either foot or both feet.
    • Black tissue (eschar) enveloping the ulcer.
    • Skin discolouration.

    How to manage diabetes foot?

    The easiest way is to prevent it in the first place.

    Follow your treatment plan along with changes in diet and exercise; this will help you to maintain the sugar levels within the normal levels.

    Monitor regularly. Regularly check your blood sugar levels and maintain the fasting levels below 110 mg/dL. Your HbA1c levels must always be below 7%.

    Complications of diabetes foot

    Ulcers, infections, gangrene (death of skin and tissue) and amputation are complications of diabetic foot.

    Treating diabetes foot?

    If ulcers develop, seek medical attention immediately without delay. See a diabetes specialist or surgeon who will clean the wound, remove any damaged areas and put you on antibiotics.

    If you take medicines regularly, with proper hygiene and utmost care, infection due to ulcers can be healed.

    Once done, work out a strict regimen to keep your blood sugar levels under control.

    Also, employ the below measures to take care of your foot:

    Warm water

    Treat the soles of your feet, the arch, and all your toes to gentle warm water baths. Try a massage when they’re dipped in to further improve circulation.

    Wear the right shoes

    The wrong pair of shoes can make this condition more insufferable than it already is. Wear the right sized shoes to ensure that no extra pressure is placed on your foot.

    Exercise right

    Too much impact exercise can prolong the damage, causing it to take longer to heal, but exercise is a must. What then?

    Try gentler exercises that get your heart pacing but are gentle on your feet. Swimming , yoga, tai chi and cycling can keep your body in tip-top shape while allowing your feet the rest they need to heal right up.

    Also, give up smoking and keep moving your feet, ankles and toes regularly.

    Remember that with proper care and precautions, you can manage diabetes foot and live a healthy life.

     

     

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  • The anatomy of healthy eating

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    The anatomy of healthy eating

    There are 3 kinds of people in the world:

    1) Those who know the right thing and do the right thing
    2) Those who know the right thing but do not do the right thing
    3) Those who do not know the right thing and do not do the right thing
     
    In this article, we are going to discuss about the second type of people – who know the right thing about nutrition but still eat junk food.
     

    Ever wondered why inspite of knowing the importance of good nutrition, people still consume junk food laden with empty calories? Before we dive into that, let us understand what junk food is.

    What is junk food?

    The term junk food was coined as a slang in the public interest in 1972 by Michael Jacobson, Director of the Center for Science, Washington D.C

    Junk food is any food that contains high levels of refined sugar, white flour, trans fat and saturated fat, salt, and numerous food additives; at the same time, it is lacking in proteins, fiber and important micronutrients. These foods often contain high level of calories often referred as “empty calories” in them.

    Why is junk food harmful?

    Junk food allows people to eat without planning – eat not only when it is time to eat, but also when you have spare time. Ingredients of junk foods offer great taste and make them addictive. Fat and sugar in combination are capable of producing a dopamine-driven surge of intense pleasure in people with a propensity for addictive behaviour.

    Food dense in calories, when oxidised in the body causes enormous formation of AcetylCoA. Acetyl CoA in excess is channelized out of mitochondria for its participation in other metabolic pathways like the denovo fatty acid synthesis and biosynthesis of cholesterol, which causes excess fatty acid and cholesterol formation in the body.

    The high levels of sugar in junk food which puts metabolism under stress; when refined sugar is consumed , the pancreas secretes high amounts of insulin to prevent a dangerous spike in blood sugar levels. Because fast food and junk food do not contain adequate amounts of protein and good carbohydrates, the blood sugar levels suddenly drops after eating, resulting in grumpy, fatigued feeling and a craving for sugar.

    Brain scans show a reduced hedonic response when subjects view a plate of vegetables versus a higher calorie alternative. Depressing, isn’t it?

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    The Food Pleasure Equation postulates that the brain quantifies pleasure from an eating experience based upon the response from its dopamine neurons and the sensing of calories by the gut. When a food is presented to you, the brain actually calculates how much pleasure will be generated during the eating and digestion of a particular food. The goal of the brain, gut, and fat cell is to maximize the pleasure extracted from the eating experience. If a food is lowered in calories for health reasons, the gut has the ability to sense this, and the food will become less palatable over time. Therefore, to keep the food pleasure elevated, one must add additional sensation in it through spices, flavour etc.

    Why is junk food more addictive?

    In the book Sensible Nutrition, the author James Clear talks about a range of factors that make junk food more addictive. These factors include:

    Dynamic contrast. Dynamic  contrast refers to a combination of different sensations in the same food. Foods with dynamic contrast often have a crunch followed by something soft or creamy and full of  taste­active compounds. This rule applies to a variety of our  favorite food structures — the caramelized top of ice cream, a slice of pizza, or a chocolate cookie — the brain finds crunching through something like this very novel and thrilling.

    Salivary response. Salivation is part of the experience of eating food and the more that a food causes you to salivate, the more it will swim throughout your mouth and cover your taste buds. For example, emulsified foods like butter, chocolate, salad dressing, ice cream, and mayonnaise promote a salivary response that helps to lather your taste buds with goodness. This is one reason why many people enjoy foods that have sauces or cheese dressing on them. The result is that foods that promote salivation do a happy little tap dance on your brain and taste better than ones that don’t.

    Rapid food meltdown and vanishing caloric density. Foods that rapidly vanish or “melt in your mouth” signal to your brain that you’re not eating as much as you actually are. In other words, these foods literally tell your brain that you’re not full, even though you’re eating a lot of calories. The result: you tend to overeat.

    Sensory specific response. Your brain likes variety. When it comes to food, if you experience the same taste over and over again, then you start to get less pleasure from it. In other words, the sensitivity of that specific sensor will decrease over time. This can happen in just minutes. Junk foods, however, are designed to avoid this sensory specific response. They provide enough taste to be interesting (your brain doesn’t get tired of eating them).

    Calorie density. Junk foods are designed to convince your brain that it is getting nutrition, but to not fill you up. Receptors in your mouth and stomach tell your brain about the mixture of proteins, fats, carbohydrates in a particular food, and how filling that food is for your body. Junk food provides just enough calories that your brain says, “Yes, this will give you some energy” but not so many calories that you think “That’s enough, I’m full.” The result is that you crave the food to begin with, but it takes quite some time to feel full from it.

    Memories of past eating experiences. This is where the psychobiology of junk food really works against you and your body. When you eat something tasty (say, a bag of potato chips), your brain registers that feeling. The next time you see that food, smell that food, or even read about that food, your brain starts to trigger the memories and responses that came when you ate it. These memories can actually cause physical responses like salivation and create the “mouth­watering” craving that you get when thinking about your favorite foods. Millions of dollars spent in advertising these food products, ofcourse further facilitates this feeling.

     

    Is there a way to start eating heathy?

    The good news is that research shows that the less junk food you eat, the less you crave for it. The more you start eating healthier, the craving for junk food gradually starts reducing. More and more awareness should be created on healthy eating and avoiding junk food.

    Remember, it is good to know the right thing; But even more important to do the right thing.
     
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